Advancing flaps for improved facial reconstruction

February 18, 2018

Flaps are key elements in facial reconstruction. Familiar flap techniques are evolving and new techniques are being introduced. These practices contribute to reconstructions that would have been considered difficult to impossible in the recent past. This topic was front and center at Friday’s forum “Techniques for Flap Success”(F022).

Anna A. Bar, MD

“Even the most familiar and well-established reconstructive techniques, such as island pedicle flaps, are evolving,” said co-session director Anna A. Bar, MD. “Most dermatologists are familiar with island pedicle flaps that move straight over, but we can now use island pedicle flaps that swing, that turn, that are larger than might be expected, and are used for different areas of the face than they were not so many years ago.”

There are new techniques for undermining and anchoring flaps, new developments in free margins, and approaches to avoid or minimize distortion. Advances in flap design and suturing have improved aesthetic outcomes and reduced the visible effects of scarring.

Continuing research has also led to the design of entirely new types of flaps. Many facial reconstructive surgeons are familiar with bilobe flaps, typically used for nasal reconstruction. Defects that are too large for bilobe reconstruction or in the wrong anatomical position can now be reconstructed using trilobe flaps. Interpolated and paramedian flap techniques have also been improved, as have periocular and ear reconstruction techniques.

“An even newer technique is tunneled and transposed flaps, which allows the surgeon to tunnel a flap under the skin and transpose it to the location of the defect,” said Dr. Bar, assistant professor of dermatology at Oregon Health & Science University. “Because the flap goes beneath the skin to the new location, it does not need to be unhooked from the original blood supply. That makes for a simpler procedure with improved results.”